Chen Shigong

Chen Shigong a physician and surgeon of the Ming dynasty (1555-1636) who is regarded as one of the founders of Chinese surgery and who, in a long life of practice and writing, established systematic approaches to the treatment of wounds, abscesses and diseases of the external body.

Life and Career

Chen Shigong, whose courtesy name was Yuren, was born in 1555 in Nantong, in what is now Jiangsu province, in the middle years of the Ming dynasty. He came from a family of physicians, and from an early age he studied the classical medical books, but he was especially drawn to the treatment of diseases of the exterior of the body, the wounds, sores and swellings that other physicians often neglected. He served for a time in official medical positions, gaining appointment to the imperial medical service.

According to tradition he obtained his knowledge in part from a remarkable teacher, a physician who had received the secret methods of surgery from a wandering practitioner and who entrusted a manuscript of surgical lore to him. Whether or not the story is literal, it reflects the way in which surgical knowledge was passed down in the tradition. Chen Shigong combined this inherited material with his own extensive clinical experience and with the study of the classical texts.

He lived to an advanced age, practising medicine for some sixty years, and he was said to have treated more than a hundred thousand patients and to have performed a great number of operations. He held official rank in the imperial medical bureau and was honoured for his skill by the court. His long career and the breadth of his experience gave him exceptional authority in the treatment of external disease.

Surgery and External Disease

Chen Shigong's reputation rests chiefly on his mastery of surgery, in an age when the treatment of wounds, tumours, abscesses and skin disease was regarded as a distinct and difficult branch of medicine. He dealt with traumatic injuries, with infections of the skin and flesh, with diseases of the bones and joints, and with disorders of the breast, the throat and the rectum, and he brought to them a systematic method of diagnosis and treatment. His work helped to establish surgery as an organised discipline within Chinese medicine.

He insisted that the treatment of external disease required attention to the whole patient and not merely to the local lesion, holding that many skin and flesh disorders arose from internal imbalance and must be treated by correcting the underlying condition. He therefore combined local treatment, including the use of salves, washes, poultices and drainage, with internal remedies that addressed the constitutional cause. This integrated approach was a distinctive feature of his practice.

He described methods for the surgical opening of abscesses, for the removal of dead tissue, for the setting and care of fractures, and for the treatment of chronic ulcers that refused to heal. He also discussed the use of anaesthesia for operations, drawing on the older accounts of the legendary physician Hua Tuo, and he considered the indications and the dangers of operative treatment. His writings give a vivid picture of the state of surgery in late Ming China.

The Orthodox Manual of Surgery

Chen Shigong's great work, published in 1617, bears a title that has been rendered as the Orthodox Manual of External Medicine. It is a comprehensive treatise on surgery and external disease, arranged in sections that cover the anatomy and physiology relevant to external medicine, the general principles of diagnosis and treatment, and a large number of specific diseases with their signs and remedies. It became the standard work on the subject for centuries.

The book describes in remarkable detail the appearance and course of many conditions, including abscesses, carbuncles, ulcers, haemorrhoids, diseases of the breast, injuries to the head and limbs, and the effects of bites and burns. For each, Chen Shigong gave a reasoned account of its cause, its diagnosis and the treatment, combining traditional classifications with the observations of his own practice. The careful description of disease in the text allows modern readers to recognise many of the conditions he treated.

The manual also records a large number of prescriptions, both for internal use and for external application, including ointments, powders, plasters and lotions. Some of the remedies were traditional, while others appear to have been his own inventions or additions, and they were valued for their practical effectiveness. The collection gives the work enduring value as a compendium of surgical therapeutics.

Bravery, Ethics and Method

Chen Shigong was celebrated not only for his skill but for his courage in undertaking cases that other physicians refused. He treated wounds and infections that were considered beyond help, and he was willing to operate where the risk was great and the prospects doubtful. His readiness to attempt the difficult case became part of his legend and exemplified the ideal of the surgeon who does not abandon the patient out of fear for his own reputation.

He also wrote about the duties and character of the physician, insisting that surgeons must be decisive and not timid, and that hesitation in the face of a curable condition was itself a kind of failure. At the same time he warned against reckless intervention and stressed the importance of correct diagnosis before treatment. This balance of boldness and prudence was central to his conception of surgical practice.

His example helped to raise the standing of surgery, which had sometimes been regarded as inferior to the internal medicine of the classical tradition. By writing a scholarly and systematic treatise and by demonstrating that surgery could be practised with learning, judgement and moral seriousness, he gave the discipline a dignity that it had not always enjoyed and encouraged others to study it. His blend of technical boldness with careful reasoning offered later surgeons a model that joined the hand and the mind in a single art.

Influence and Legacy

The Orthodox Manual of External Medicine became one of the most widely used surgical texts in China and was reprinted many times over the following centuries. It shaped the education of surgeons throughout the late Ming and the Qing dynasties and was carried to Korea and Japan, where it was studied and commented upon. Its influence on the practice of external medicine lasted well into the modern period.

Chen Shigong's emphasis on treating the whole patient, on the importance of exact diagnosis, and on the combination of local and constitutional therapy anticipated principles that remain central to surgical practice. His records of specific cases and treatments preserved knowledge that might otherwise have been lost, and his descriptions of disease have proved valuable to historians of medicine seeking to understand the range of conditions that physicians of his time confronted and treated.

He died in 1636, near the end of the Ming dynasty and on the eve of the great upheavals of the seventeenth century. He is remembered as the outstanding surgeon of his age and as the physician who gave Chinese surgery one of its few comprehensive and scholarly treatises, a work that continues to be cited by those who study the history of the healing art. His manual preserved the practical knowledge of generations and transmitted it, ordered and explained, to physicians who would otherwise have had to rediscover it through long and painful experience of their own.

See also

• Traditional Chinese medicine
• History of surgery
• Ming dynasty
• Hua Tuo